目的:本研究旨在评估接受腰椎融合手术(LFS)的退行性腰椎滑脱(DLS)患者的术前(术前)影像学特征和特定的手术干预措施,重点分析节段性腰椎前凸(SLL)术后恢复的预测因素。
方法:在单中心进行的回顾性审查确定了在2016年至2022年期间连续接受LFS的单水平DLS患者。射线照相测量包括盘角(DA),SLL,腰椎前凸(LL),前/后椎间盘高度(ADH/PDH),脊椎滑脱百分比(SP),椎间盘退变,和椎旁肌肉质量。手术相关的措施包括笼子的位置,螺钉插入深度,腰椎滑脱减少率,和椎间盘高度恢复率。SLL≥4°的变化表明节段性腰椎前凸度(ISLL)增加,和未增加的节段性腰椎前凸度(UISLL)<4°。倾向评分匹配用于ISLL和UISLL患者之间基于年龄的1:1匹配,性别,身体质量指数,吸烟状况,和骨质疏松症的情况。
结果:共纳入192例患者,平均随访20.9个月。与UISLL患者相比,ISLL患者的术前DA显着降低(6.78°vs.11.84°),SLL(10.73°vs.18.24°),LL(42.59°vs.45.75°),和ADH(10.09毫米vs.12.21mm)(全部,P<0.05)。ISLL患者倾向于更严重的椎间盘退变(P=0.047)和更高的SP(21.30%vs.19.39%,P=0.019)。ISLL患者的笼子位置更靠前(67.00%vs.60.08%,P=0.000),腰椎滑脱的减少更广泛(-73.70%vs.-56.16%,P=0.000)和更高的ADH恢复(33.34%vs.8.11%,P=0.000)。多因素回归显示术前SLL较低(OR0.750,P=0.000),更多的前笼位置(OR1.269,P=0.000),腰椎滑脱减少率(OR0.965,P=0.000)显着影响SLL的恢复。
结论:术前SLL,保持架位置,腰椎滑脱减少率被确定为DLSLFS后SLL恢复的重要预测因子。建议外科医生根据术前SLL精心选择患者,并努力将笼子定位在更靠前的位置,同时最大程度地减少脊椎滑脱,以最大程度地恢复SLL。
OBJECTIVE: This study aimed to evaluate preoperative (pre-op) radiographic characteristics and specific surgical interventions in patients with degenerative lumbar spondylolisthesis (DLS) who underwent lumbar fusion surgery (LFS), with a focus on analyzing predictors of postoperative restoration of segmental lumbar lordosis (SLL).
METHODS: A retrospective review at a single center identified consecutive single-level DLS patients who underwent LFS between 2016 and 2022. Radiographic measures included disc angle (DA), SLL, lumbar lordosis (LL), anterior/posterior disc height (ADH/PDH), spondylolisthesis percentage (SP), intervertebral disc degeneration, and paraspinal muscle quality. Surgery-related measures included cage position, screw insertion depth, spondylolisthesis reduction rate, and disc height restoration rate. A change in SLL ≥ 4° indicated increased segmental lumbar lordosis (ISLL), and unincreased segmental lumbar lordosis (UISLL) < 4°. Propensity score matching was employed for a 1:1 match between ISLL and UISLL patients based on age, gender, body mass index, smoking status, and osteoporosis condition.
RESULTS: A total of 192 patients with an average follow-up of 20.9 months were enrolled. Compared to UISLL patients, ISLL patients had significantly lower pre-op DA (6.78° vs. 11.84°), SLL (10.73° vs. 18.24°), LL (42.59° vs. 45.75°), and ADH (10.09 mm vs. 12.21 mm) (all, P < 0.05). ISLL patients were predisposed to more severe intervertebral disc degeneration (P = 0.047) and higher SP (21.30% vs. 19.39%, P = 0.019). The cage was positioned more anteriorly in ISLL patients (67.00% vs. 60.08%, P = 0.000), with more extensive reduction of spondylolisthesis (- 73.70% vs. - 56.16%, P = 0.000) and higher restoration of ADH (33.34% vs. 8.11%, P = 0.000). Multivariate regression showed that lower pre-op SLL (OR 0.750, P = 0.000), more anterior cage position (OR 1.269, P = 0.000), and a greater spondylolisthesis reduction rate (OR 0.965, P = 0.000) significantly impacted SLL restoration.
CONCLUSIONS: Pre-op SLL, cage position, and spondylolisthesis reduction rate were identified as significant predictors of SLL restoration after LFS for DLS. Surgeons are advised to meticulously select patients based on pre-op SLL and strive to position the cage more anteriorly while minimizing spondylolisthesis to maximize SLL restoration.